Republican Alternatives to Obamacare

Many Republicans saw the repeal of ObamaCare as one of the largest benefits of having Trump in the White House. “How soon will it be gone?” is the question that many began asking as soon as the president began discussing his plans for dismantling the Affordable Care Act. However, for all of those who are enrolled in the program and the public at large, whose tax dollars often pay for those who do not have insurance, there is a larger question on the table. “What will be replacing it?” Everyone who has watched the controversy surrounding the American healthcare system is left wondering what the Republican alternatives to ObamaCare are. Much to the frustration of many, at first the GOP announced no replacement plan, simply stating that they would be repealing the Affordable Care Act. Over 20 million people are covered by the ACA, causing fears that a repeal with no replacement could cause instability in the insurance markets and strain the still tenuous economy. After mounting pressure to create a replacement, in mid January 2017, Republicans approached Congress with their plan.

Keep ObamaCare If You Want

Senators Bill Cassidy of Louisiana and Susan Collins of Maine announced the plan. Central to their proposal is placing the power of healthcare decisions in the hands of the states. This includes one important and unexpected declaration: any state that is satisfied with ObamaCare can keep it. Senator Cassidy stated, “Republicans think that if you like your insurance, you should keep it. And we mean it. They could opt to stay in Obamacare or they could opt for no federal help. So, California and New York, you love Obamcare? You can keep it.”

Collins has been adamant that ObamaCare should not be repealed until there is a replacement in place, in order to prevent lapses in coverage. She also recognizes that their bill is a work in progress, and does not plan to see it implemented until 2019, stating “We recognize that our bill is not perfect. It is still a work in progress. I expect that we will get many ideas from my colleagues for further refinements and we are completely open to that. But if we do not start putting specific legislation on the table that can be debated, refined, amended and enacted, then we will fail the American people.”

Opting Out

For those that do not wish to keep ObamaCare, Cassidy and Collins’ plan gives two options. They proposed to put a default plan in place for anyone dropping the ACA to enroll in. All ObamaCare recipients who wish to transition would automatically be enrolled in this catastrophic plan, which would be also coupled with a subsidized health savings account. Anyone who wished to would also be given the option to opt out of health insurance entirely. The default plan would be funded by transferring authorized federal spending on beneficiaries to the states. While this default plan does not offer the same level of care to everyone as the ACA does, it may offer a tradeoff that some have considered reasonable: cover more people, but with fewer guaranteed benefits. This may not be what the Democrats were looking for in exchange for the Affordable Care Act, but it offers a better trade off than many expected.

Democratic Objections

Democrats were quick to object to the alternatives put on the table. “Millions of Americans would be kicked off their plans, out-of-pocket costs and deductibles for consumers would skyrocket, employer-based coverage for working families would be disrupted, and protections for people with pre-existing conditions, such as cancer, would be gutted. All while the wealthiest few get a tax cut,” Senate Minority Leader Chuck Schumer stated. “It is nearly impossible to keep the benefits of the Affordable Care Act without keeping the whole thing.”

Schumer was adamant that the biggest problem with the alternative was that no alternative could be as good as ObamaCare. “While I have a great deal of respect for senators Collins and Cassidy, their proposal today illustrates the dilemma both they and Republicans are in,” Schumer said. “Ultimately, this proposal is an empty facade that would create chaos—not care—for millions of Americans. Republicans should drop their disruptive repeal plans and work with Democrats to improve, not gut, the Affordable Care Act and healthcare system for all Americans.”

Medicaid Troubles

Over half of the 20 million people who are enrolled in ObamaCare did so through Medicaid. This puts an extra strain on Republicans trying to find an alternative, as Medicaid overhaul would also be called for. Part of the ACA was an expanded Medicaid eligibility. Many who voted for this expansion, including some Republicans, are in favor of keeping it. However, it is unclear whether this is part of the proposed alternative to ObamaCare at this time.

Those who are in favor of repealing this expansion, such as Paul Ryan, have proposed to roll back the expansion of Medicaid and give each state a fixed amount of money for each beneficiary or a lump sum for all of a state’s Medicaid program.This would give states more freedom to set benefits and program rules, but the federal government would be able to cut Medicaid spending compared with the amounts projected under current law.

Pre-Existing Conditions

One major concern many have with any alternative to ObamaCare is coverage for those with pre-existing conditions. The Affordable Care Act prohibits insurers from denying coverage or charging higher premiums because a person has a pre-existing condition like cancer, heart disease, diabetes or AIDS. The Trump administration has stated that they are in support of this provision, and have no intention of getting rid of it. The only difference in their proposal is that to obtain full protection, consumers would need to maintain “continuous coverage.” The theory behind this method is that this clause will encourage consumers to obtain and maintain coverage. Democrats argue that many experience gaps in coverage for legitimate reasons, and so far it is unclear if there are any exceptions to the definition of “continuous coverage” under the Republican alternatives to ObamaCare.